Published online Sep 18, 2018. doi: 10.5312/wjo.v9.i9.173
Peer-review started: April 10, 2018
First decision: May 15, 2018
Revised: May 20, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: September 18, 2018
To perform an Internet based survey on the surgical management of bone sarcomas in the lower extremity amongst sarcoma surgeons.
All orthopedic surgical members of the Scandinavian Sarcoma Group were invited to participate in an online questionnaire. The questionnaire consisted of a clinical case involving resection of a malignant bone tumor. Several questions were asked, subdivided into categories. Among these, surgical/technical considerations, e.g., choice of implant; choice of antibiotics, dosage, and duration of treatment, choice of antithrombotic drug, initial start-up, dosage, and duration were included.
In terms of choice of implant fixation, the majority of surgeons preferred an uncemented prosthesis in younger patients until the age of 50. All participants administer intravenous prophylactic antibiotics for endoprosthetic reconstructive surgery. First choice of antibiotics was cephalosporin. Less common used was glycopeptide, penicillin, or a combination. Duration of prophylactic antibiotics ranged from less than one day to more than four days. All participants used low molecular weight heparins as antithrombotic prophylaxis and 55% of the participants answered that initial treatment was started preoperatively, 3% perioperatively and 42% postoperatively. Duration of the antithrombotic treatment ranged from five days to more than twenty-eight days.
The use of resection prosthesis in the treatment of bone sarcomas is a well-established procedure. However, therse is a significant discrepancy in the surgical treatment algorithm between the sarcoma centers. Still the treatment is mainly based on best clinical practice, due to the lack of evidence-based medicine in the surgical management of bone sarcomas.
Core tip: Today the majority of patients diagnosed with bone sarcomas located in the lower extremities are offered reconstruction with a megaprosthesis. However, no clear golden standard is available in the international surgical oncology community with regard to choice of implant, choice of antibiotics, dosage, and duration of treatment, or choice of antithrombotic drug, initial start-up, dosage, and duration. The current study reveals a clear lack of consensus.